Provider Demographics
NPI:1871654970
Name:RAULERSON & RAULERSON PHYSICIANS
Entity Type:Organization
Organization Name:RAULERSON & RAULERSON PHYSICIANS
Other - Org Name:LOWER ALABAMA PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAULERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-867-3608
Mailing Address - Street 1:1205 BELLEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-1304
Mailing Address - Country:US
Mailing Address - Phone:251-867-3608
Mailing Address - Fax:251-867-3610
Practice Address - Street 1:1205 BELLEVILLE AVE
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-1304
Practice Address - Country:US
Practice Address - Phone:251-867-3608
Practice Address - Fax:251-867-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL541003939Medicaid
AL541393901Medicaid
AL013939Medicare Oscar/Certification